Benefits and Eligibility Specialist

Copa Health•Pinetop-Lakeside, AZ

11d•$16 - $18

About The Position

The Benefit & Eligibility Specialist is responsible for navigating and optimizing various benefit programs while assessing and assisting members with obtaining benefits. Assist members with AHCCCS eligibility and enrollment. Establish positive, effective, and professional relationships with members, families, colleagues and other components of the healthcare payor system.

Requirements

Requires any combination of training, education, and experience listed below:
High School Diploma/GED
Minimum of two years' experiencein an office clerical setting.
Must have a fingerprint clearance card issued by the AZ Department of Public Safety or eligible to receive on within eight (8) week of hire.
TB Test clearance required at the time of hire and annually.
Proficiency in typing, using computer software, i.e., EHR/EMR systems and MS Office.
Ability to maintain confidentiality and adhere to all HIPAA regulations.
Demonstrated ability to communicate, problem solve, and work effectively in an individual and team environment.
Demonstrated ability to remain calm and use the proper de-escalation methods in crisis situations.
Demonstrate an understanding of current Medicaid/Medicare/Marketplace information and systems.
Ability to adhere to agency procedures, licensing and accreditation standards related to health and safety are maintained.
Demonstrate superior work habits to include, but not limited to the following: time management, initiative, role modeling, leadership, organizational skills, and multitasking.
Ability to work in a fast-paced environment.

Nice To Haves

Experience working in a medical and or behavioral health setting is highly preferred.

Responsibilities

Verifies, ensures accuracy, and updates patient demographics and insurance information.
Assist Office Assistants in the maintenance of accurate, up to date-to-date insurance verification.
Use online web-based verification systems and reviews real-time eligibility responses to ensure the accuracy of insurance eligibility.
Collects, verifies, and communicates necessary information with members' insurance carriers to obtain benefits and eligibility information.
Complete, process, submit, and track prior authorizations.
Initiates and assists patients with completing applications for Medicaid, Medicare, and SSI/SSDI.
Screen persons to determine eligibility for Medicaid assistance and re-determine their continuing eligibility.
Establish rapport and credibility with customers and providers by providing excellent customer service in a professional manner.
Performs quality checks on all eligibility initiated and ensures there are process for all members who do not a valid, accurate, current insurance.
Process eligibility case files within the required timeframes established by applicable funding source.
Facilitate eligibility screening and ongoing monitoring.
Process eligibility files into the company EHR/EPM system.
Investigates and resolves denial cases of members who lose eligibility.
Performs other administrative tasks to support the operations of the outpatient site.
Adherence to all agency policies, licensure, and training requirements.
To ensure compliance & adequate services, additional job duties may be required to meet the needs of the program and or department.